House Speaker Paul Ryan holds up a copy of the American Health Care Act during a news conference in Washington in March. House Majority Leader Kevin McCarthy, left, joined the 13 other House members of California’s Republican delegation in voting for the GOP bill earlier this month. (Zach Gibson/Bloomberg via Getty Images)

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Though the budget analysis released Wednesday on the GOP health care bill didn’t address California specifically, both the state’s Medicaid program and its individual market could be seriously harmed if the legislation passes, according to legislators, consumer advocates and other critics.

“I feel like I am in a bad dream,” said Sen. Ed Hernandez, the West Covina Democrat who chairs the state Senate Health Committee.

The Congressional Budget Office confirmed what Hernandez expected — that large numbers of people would lose coverage and poorer, older Californians would pay significantly more for coverage under the American Health Care Act.

The Republican bill passed the House of Representatives earlier this month with no Democratic support and is now in the hands of the Senate, which is working on its own version.

Hernandez said he’s especially concerned about the changes to the Medicaid program, known as Medi-Cal in California. “The state budget is not going to be able to absorb this,” he said. “We are going to have a real problem.”

All 14 members of California’s Republican delegation in the House voted for the GOP bill. Like their counterparts nationally, several have said that President Obama’s signature health law was failing and that the new legislation would offer consumers more choice and better care at better prices.

But critics said the law would roll back much of what California had achieved when it heartily embraced the Affordable Care Act, which brought the state’s uninsured rate to record lows.

Nationally, the $119 billion in savings projected by the CBO over a 10-year period doesn’t seem worth the anticipated cost of adding 23 million to the rolls of the uninsured, said John Baackes, CEO of LA Care Health Plan.

In California, Baackes said, the cuts to Medi-Cal “will create a huge gap that the state would have to fill.” And he said it could end the Medicaid expansion ushered in by the Affordable Care Act. Since the law took effect, about 5 million more people enrolled in Medi-Cal, including 3.7 million who became newly eligible under the expansion.

An earlier analysis of the House bill by the California Department of Health Care Services, which oversees the state’s Medicaid program, estimated that the state would lose more than $24 billion annually by 2027 compared to what it would have received under the ACA.

Covered California officials declined to comment on the budget analysis Wednesday but have said in the past that the GOP legislation would make coverage unaffordable for many Californians, especially those who have lower incomes and live in pricier areas.

If California does not keep the 10 essential benefits spelled out under the ACA and continue to prohibit higher premiums for those with preexisting conditions, the individual market in the state would be destabilized, said Laurel Lucia, a health care researcher at the University of California-Berkeley Labor Center.

For many people, the Republican proposal also would reduce premium subsidies for Covered California plans, which Lucia said would make coverage less affordable. And proposed caps on federal Medicaid spending would tightly squeeze the California program, she said.

“Overall there would be substantial loss of coverage for low- and middle-income Californians, especially older Californians,” Lucia said.

Jen Flory, a policy advocate at the Western Center on Law & Poverty in California, said the CBO report shows that “drastic cuts to Medicaid are largely offsetting tax cuts for wealthy Americans.”

Flory said she also feared that that optional Medi-Cal benefits under the law — such as prescription drugs and nursing home care — would be at risk. “The state would be faced with some really tough choices,” Flory said.

Carmela Castellano-Garcia, CEO of CaliforniaHealth+ Advocates, said the CBO score is “devastating.”

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